While most plan sponsors have emergency medical travel insurance as part of their group insurance plan not everyone is aware of what exclusions could deny coverage for an insured individual. It is important that plan sponsors have a thorough knowledge of the details of their travel coverage and that the information is communicated to the employees.
The contract may not always provide all the necessary details to evaluate the coverage provided by the plan; therefore, it is important that plan sponsors—employees—ask the insurer the proper questions.
Most employees would assume that their travel coverage insures them regardless of where they are travelling, where they receive medical treatment, what they were doing at the time of the medical emergency and any pre-existing conditions that they had prior to departing on their trip. However, that isn’t always the case
Plan sponsors and employees simply cannot assume everything is insured; otherwise, an employee could be responsible for an expensive and unexpected medical bill.
Here are some key aspects of an emergency medical travel plan that plan sponsors and employees should be aware of when reviewing the contract.
1. What are the pre-existing medical conditions? What is the definition of a pre-existing condition that would be excluded under the emergency medical travel plan? Would an insured individual be covered if his/her physician deemed them medically stable? In the case of an expecting mother, is a pre-term delivery, a miscarriage or any complications that would arise from a pregnancy covered? Is an expecting mother covered for any medical services relative to her pregnancy afters 30 weeks, 36 weeks or is a pregnant mom insured at all?
2. Would a medical emergency be excluded if participating in certain activities? For example, would a medical emergency be covered if it was a direct result of rock climbing, mountain biking, downhill skiing (in-bounds or out-of-bounds), parasailing, kite boarding or scuba diving? While enjoying the warm sun or the snow, many would not be wondering if their travel coverage would exclude one of these activities. Also, nobody ever thinks anything is going to go wrong. Therefore, before leaving for a trip it is important that an employee ask the insurer if coverage is excluded during the participation of any activities.
3. Is there a limit on the number of days?: How long can an employee travel before their travel coverage expires? Some only offer coverage for trips less than 30 or 60 days. For those going on extended vacations this is an important question.
4. Are there any destinations excluded?: If there is any question in an insured individual’s mind that their destination may not be covered, it is highly recommended that they contact the insurer before they depart to ensure they will be covered while travelling.
5. In the event of a medical emergency, what does an insured individual have to do?: It is very important that employees are reminded they need to contact the travel insurer prior to receiving medical services to “open” the claim file. In addition, the travel insurer can immediately direct the insured individual to an approved medical facility, provide translation services and identify what services are provided with the insurance plan. If an employee does not call the insurer, they are at risk of receiving medical services from a provider that is not covered by the insurance plan or receiving services that are not insured by the plan. Too often claims are denied this step isn’t taken.
Although a contract may not provide all the details of the emergency medical travel policy, it is best that plan sponsors do not assume that all medical services are insured or that there are no exclusions. Plan sponsors need to know what they are paying for and they need to let their employees know what is—and isn’t—covered. Or, at the very least, reminding employees to look into this before they leave on vacation and where they can obtain the information.